America's nurses, an estimated 2 million strong, are often at the frontlines in confronting environmental health hazards. Yet most nurses have not received adequate training to manage these hazards. Nursing, Health, and the Environment explores the effects that environmental hazards (including those in the workplace) have on the health of patients and communities and proposes specific strategies for preparing nurses to address them. The committee documents the magnitude of environmental hazards and discusses the importance of the relationship between nursing, health, and the environment from three broad perspectives: Practiceâ€"The authors address environmental health issues in the nursing process, potential controversies over nurses taking a more activist stance on environmental health issues, and more. Educationâ€"The volume presents the status of environmental health content in nursing curricula and credentialing, and specific strategies for incorporating more environmental health into nursing preparation. Researchâ€"The book includes a survey of the available knowledge base and options for expanding nursing research as it relates to environmental health hazards.
Driven by community-based organizations and supported by a growing body of literature, the environmental justice movement contends that poor and minority populations are burdened with more than their share of toxic waste, pesticide runoff, and other hazardous byproducts of our modern economic life. Is environmental degradation worse in poor and minority communities? Do these communities suffer more adverse health effects as a result? The committee addresses these questions and explores how current fragmentation in health policy could be replaced with greater coordination among federal, state, and local parties. The book is highlighted with case studies from five locations where the committee traveled to hear citizen and researcher testimony. It offers detailed examinations in these areas: Identifying environmental hazards and assessing risk for populations of varying ethnic, social, and economic backgrounds, and the need for methodologies that uniquely suit the populations at risk. Identifying basic, clinical, and occupational research needs and meeting challenges to research on minorities. Expanding environmental education from an ecological focus to a public health focus for all levels of health professionals. Legal and ethical aspects of environmental health issues. The book makes recommendations to decision-makers in the areas of public health, research, and education of health professionals and outlines health policy considerations.
People are increasingly concerned about potential environmental health hazards and often ask their physicians questions such as: "Is the tap water safe to drink?" "Is it safe to live near power lines?" Unfortunately, physicians often lack the information and training related to environmental health risks needed to answer such questions. This book discusses six competency based learning objectives for all medical school students, discusses the relevance of environmental health to specific courses and clerkships, and demonstrates how to integrate environmental health into the curriculum through published case studies, some of which are included in one of the book's three appendices. Also included is a guide on where to obtain additional information for treatment, referral, and follow-up for diseases with possible environmental and/or occupational origins.
The environment is increasingly recognized as having a powerful effect on human and ecological health, as well as on specific types of human morbidity, mortality, and disability. While the public relies heavily on federal and state regulatory agencies for protection from exposures to hazardous substances, it often looks to health professionals for information about routes of exposure and the nature and extent of associated adverse health consequences. However, most health professionals acquire only a minimal knowledge of toxicology during their education and training. In 1967 the National Library of Medicine (NLM) created an information resource, known today as the Toxicology and Environmental Health Information Program (TEHIP). In 1995 the NLM asked the Institute of Medicine to examine the accessiblity and utility of the TEHIP databases for the work of health professionals. This resulting volume contains chapters on TEHIP and other toxicology and environmental health databases, on understanding the toxicology and environmental health information needs of health professionals, on increasing awareness of information resources through training and outreach, on accessing and navigating the TEHIP databases, and on program issues and future directions.
Toxicity testing in laboratory animals provides much of the information used by the Environmental Protection Agency (EPA) to assess the hazards and risks associated with exposure to environmental agents that might harm public health or the environment. The data are used to establish maximum acceptable concentrations of environmental agents in drinking water, set permissible limits of exposure of workers, define labeling requirements, establish tolerances for pesticides residues on food, and set other kinds of limits on the basis of risk assessment. Because the number of regulations that require toxicity testing is growing, EPA called for a comprehensive review of established and emerging toxicity-testing methods and strategies. This interim report reviews current toxicity-testing methods and strategies and near-term improvements in toxicity-testing approaches proposed by EPA and others. It identifies several recurring themes and questions in the various reports reviewed. The final report will present a long-range vision and strategic plan to advance the practices of toxicity testing and human health assessment of environmental contaminants.
Expanding water reuse-the use of treated wastewater for beneficial purposes including irrigation, industrial uses, and drinking water augmentation-could significantly increase the nation's total available water resources. Water Reuse presents a portfolio of treatment options available to mitigate water quality issues in reclaimed water along with new analysis suggesting that the risk of exposure to certain microbial and chemical contaminants from drinking reclaimed water does not appear to be any higher than the risk experienced in at least some current drinking water treatment systems, and may be orders of magnitude lower. This report recommends adjustments to the federal regulatory framework that could enhance public health protection for both planned and unplanned (or de facto) reuse and increase public confidence in water reuse.
Advances in molecular biology and toxicology are paving the way for major improvements in the evaluation of the hazards posed by the large number of chemicals found at low levels in the environment. The National Research Council was asked by the U.S. Environmental Protection Agency to review the state of the science and create a far-reaching vision for the future of toxicity testing. The book finds that developing, improving, and validating new laboratory tools based on recent scientific advances could significantly improve our ability to understand the hazards and risks posed by chemicals. This new knowledge would lead to much more informed environmental regulations and dramatically reduce the need for animal testing because the new tests would be based on human cells and cell components. Substantial scientific efforts and resources will be required to leverage these new technologies to realize the vision, but the result will be a more efficient, informative and less costly system for assessing the hazards posed by industrial chemicals and pesticides.
Children are the foundation of the United States, and supporting them is a key component of building a successful future. However, millions of children face health inequities that compromise their development, well-being, and long-term outcomes, despite substantial scientific evidence about how those adversities contribute to poor health. Advancements in neurobiological and socio-behavioral science show that critical biological systems develop in the prenatal through early childhood periods, and neurobiological development is extremely responsive to environmental influences during these stages. Consequently, social, economic, cultural, and environmental factors significantly affect a child's health ecosystem and ability to thrive throughout adulthood. Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity builds upon and updates research from Communities in Action: Pathways to Health Equity (2017) and From Neurons to Neighborhoods: The Science of Early Childhood Development (2000). This report provides a brief overview of stressors that affect childhood development and health, a framework for applying current brain and development science to the real world, a roadmap for implementing tailored interventions, and recommendations about improving systems to better align with our understanding of the significant impact of health equity.
Building on the revolutionary Institute of Medicine reports To Err is Human and Crossing the Quality Chasm, Keeping Patients Safe lays out guidelines for improving patient safety by changing nurses' working conditions and demands. Licensed nurses and unlicensed nursing assistants are critical participants in our national effort to protect patients from health care errors. The nature of the activities nurses typically perform â€" monitoring patients, educating home caretakers, performing treatments, and rescuing patients who are in crisis â€" provides an indispensable resource in detecting and remedying error-producing defects in the U.S. health care system. During the past two decades, substantial changes have been made in the organization and delivery of health care â€" and consequently in the job description and work environment of nurses. As patients are increasingly cared for as outpatients, nurses in hospitals and nursing homes deal with greater severity of illness. Problems in management practices, employee deployment, work and workspace design, and the basic safety culture of health care organizations place patients at further risk. This newest edition in the groundbreaking Institute of Medicine Quality Chasm series discusses the key aspects of the work environment for nurses and reviews the potential improvements in working conditions that are likely to have an impact on patient safety.
The United States is rapidly transforming into one of the most racially and ethnically diverse nations in the world. Groups commonly referred to as minorities-including Asian Americans, Pacific Islanders, African Americans, Hispanics, American Indians, and Alaska Natives-are the fastest growing segments of the population and emerging as the nation's majority. Despite the rapid growth of racial and ethnic minority groups, their representation among the nation's health professionals has grown only modestly in the past 25 years. This alarming disparity has prompted the recent creation of initiatives to increase diversity in health professions. In the Nation's Compelling Interest considers the benefits of greater racial and ethnic diversity, and identifies institutional and policy-level mechanisms to garner broad support among health professions leaders, community members, and other key stakeholders to implement these strategies. Assessing the potential benefits of greater racial and ethnic diversity among health professionals will improve the access to and quality of healthcare for all Americans.
Roughly half of all deaths in the United States are linked to behavioral and social factors. The leading causes of preventable death and disease in the United States are smoking, sedentary lifestyle, along with poor dietary habits, and alcohol consumption. To make measurable improvements in the health of Americans, physicians must be equipped with the knowledge and skills from the behavioral and social sciences needed to recognize, understand, and effectively respond to patients as individuals, not just to their symptoms. What are medical schools teaching students about the behavioral and social sciences? In the report, the committee concluded that there is inadequate information available to sufficiently describe behavioral and social science curriculum content, teaching techniques, and assessment methodologies in U.S. medical schools and recommends development of a new national behavioral and social science database. The committee also recommended that the National Board of Medical Examiners ensure that the U.S. Medical Licensing Examination adequately cover the behavioral and social science subject matter recommended in this report.
Occupational health nurses (OHNs) are front-line advocates for preventing illness and injury and protecting health in a variety of workplace settings, including the areas of agriculture, construction, health care, manufacturing, and public safety. OHNs need education and training in respiratory protection in order to ensure both their safety and the safety of America's workers. At the request of the National Personal Protective Technology Laboratory of the National Institute for Occupational Safety and Health, the Institute of Medicine (IOM) examined existing respiratory protection curricula and made recommendations to improve education and training in respiratory protection for OHNs. The IOM finds that current respiratory protection education receives varying amounts of dedicated time and resources and is taught using a variety of approaches. Several recommendations are made to improve the respiratory protection education and training of OHNs.
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